Early seizures after temporal lobectomy predict subsequent seizure recurrence

Authors

  • Anne M. McIntosh PhD,

    1. Epilepsy Research Centre, University of Melbourne
    2. School of Nursing, University of Melbourne
    3. Department of Medicine (Neurology), University of Melbourne
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  • Renate M. Kalnins FRACP,

    1. Department of Anatomical Pathology, Austin Health, Melbourne, Victoria, Australia
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  • L. Anne Mitchell FRACR,

    1. Department of Radiology, Austin Health, Melbourne, Victoria, Australia
    2. Department of Radiology, University of Melbourne
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  • Samuel F. Berkovic MD

    Corresponding author
    1. Epilepsy Research Centre, University of Melbourne
    2. Department of Medicine (Neurology), University of Melbourne
    3. Department of Neurology, Austin Health, Melbourne, Victoria, Australia
    • Epilepsy Research Centre (Repatriation Campus) Austin Health, Melbourne, Victoria 3081, Australia
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Abstract

Patients are understandably anxious if seizures occur immediately after temporal lobectomy. Such “neighborhood” seizures are commonly regarded as irrelevant to seizure outcome and discounted in outcome measurement. We conducted an in-depth examination of early postoperative seizures (<28 days) and outcome. The risk of recurrence at one postoperative year was calculated using Poisson regression, and statistical adjustments were made for preoperative pathology. Of 321 patients, 69 (22%) experienced early postoperative seizures. These early seizures were associated with subsequent seizure recurrence (rate ratio [RR] 5.9; 95% confidence interval [CI], 4.1–8.4). Among patients with early seizures, the only significant factor was the presence of seizure precipitants, which was associated with a lower recurrence risk. However, when compared with patients with no early seizures, those with precipitants to early seizures had a higher risk of recurrence (RR, 3.0; 95% CI, 1.8–5.2). The risk was higher again for patients without precipitants to early seizures (RR, 7.6; 95% CI, 5.0–11.5). Early seizures and other seizure recurrences in the first postoperative year did not differ in their effect on subsequent outcome (X2 [3] = 3.4, p = 0.33). We conclude that early postoperative seizures are associated with subsequent seizure recurrence. These findings have implications for patient counseling and the measurement of outcome. Ann Neurol 2005;57:283–288

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